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Primary Care Misconceptions

Six questions to ask yourself to determine if Direct Primary Care is right for you:

  1. Do you want more time with your doctor and one who is less distracted?
  2. Do you want more proactive and less reactive healthcare?
  3. Do you want a patient-physician partnership with shared decision-making?
  4. Do you want access to your physician when you need them?
  5. Do you want transparent care costs, reduced lab fees, and reduced prices for prescription medications?
  6. Do you want a clean, quiet, calm, and friendly medical home with a recognizable care team?
Six Primary Care Misconceptions:
Misconception #1: I don’t need a family physician; I have Dr. Google.
Study after study has shown that the internet is not the best place to find answers to your medical questions. Most people find themselves in rabbit holes with inaccurate and often scary diagnoses or in denial about what a physician would identify as red flags or warning signs. As a result, patients can develop fear-driven entitlement and obtain extensive and expensive workups that can result in more harm than help. Having a personal and trusting relationship with your family physician is the best assurance you can have.
Misconception #2: Primary care is simple, and any clinician can do it.
If this statement sounds true to you, consider looking for a different primary care physician. All physicians go to medical school for four intense years after college. Keep in mind that medical schools only accept “the best of the best.” After four years of studying the human body through science and clinical experience, medical students take board exams through both computer-based testing (6-8 hours) and simulated patient interactions (4 hours) to achieve their title of DO or MD. Once a doctor, physicians continue their training in a residency program. Family physicians work under seasoned “attending” physicians for an additional three years. Then, to verify sufficient knowledge, they take an additional 6-8-hour computer-based exam to become board certified. Maintaining board certification is an ongoing process of continuing education and meeting specific guidelines at the state and national levels.
Misconception #3: Family physicians are just gatekeepers who manage referrals but not real medical conditions.
Once again, if this statement feels true to you, consider a new medical home. Family physicians train in all scopes of medicine; on average, a family physician can diagnose and treat 90% of medical conditions. As common concerns occur regularly, it should be infrequent for a good family physician to need to refer to specialty care. The privilege of a family physician is multifold. It includes establishing relationships with their patients and being the primary investigator and patient advocate when needed. A wise and humble family physician can also recognize when they come across the 10% of patient ailments that require a referral for care outside the scope of primary care.
Misconception #4: All primary care is expensive.
This feeling is often valid but not a fact. Skilled family physicians utilize their experienced ears to listen, eyes to inspect, hands to touch, and hearts to feel. They process all these sensory experiences and exercise their brain power to diagnose and treat – at a cost far less than any spa treatment or lawyer fee. The expense is in high-salaried health system administrators, billing and coding teams, efficiency teams, and health insurance bureaucracy. In direct primary care, procedures like joint injections, cryotherapy, laceration repairs, abscess/cyst incision, and drainage are all included in the patient’s monthly membership.
Misconception #5: If your physician doesn’t bill your health insurance you will pay more.
Primary care offices that accept health insurance are governed by the health insurance companies and their reimbursement rates. They are also reliant on ever-changing billing and coding regulations and documentation trails. This means more staff to pay, papers to complete, and phone calls to answer. These factors steal time from what matters – the patient-physician relationship. Physicians in direct primary care have a small team and few administrative obligations, so they can afford to take the time needed with their patients. Direct primary care offices ally with direct pharmacies, imaging centers, and labs to reduce interference and costs by 20-90%, which benefits both the physician and the patient.
Misconception #6: Urgent care is a great alternative to your primary care.
Unfortunately, the urgent care environment lacks the long-standing patient-physician relationship that serves the patient in their time of need. To operate sustainably, urgent cares are typically staffed by nurse practitioners or physician assistants, which is okay; however, they do not have the same extensive training as a physician. The urgent care environment is at risk of care delivery through a lack of experience and more cookie-cutter style care. Urgent cares are designed for high volume and often accompanied by long waits. Patients who go for injury care are exposed to patients with infections, and germ spreading occurs incidentally. Communication between urgent care and primary care is limited due to the time constraints of conventional care models. Within direct primary care, your physician has intentionally protected their time to be available to you in all times of need – urgent or routine. Direct care physicians do this by limiting their patient panel and keeping schedule openings for same or next-day appointments. In direct primary care, your doctor is often available for time-sensitive afters-hours needs.
Six Tips to Select the Right Primary Care:
Tip #1: Go for the Meet & Greet.
A meet and greet allows you to assess the prospective physician for relational compatibility; this is important. Although most conventional primary care practices do not offer a meet and greet (it is not typically a billable visit), it is worth your time to understand if this primary care physician is: 1) likable, 2) a good listener, 3) trustworthy, and 4) someone in whom you could allow professional vulnerability. This should be a brief free appointment to understand the medical practice’s environment and team and help you decide if you want to make it your medical home.
Tip #2: Go for the physician who is like-minded.
You’ve heard the phrase: You get what you pay for, and this statement holds much truth. If you appreciate quality more than quantity, direct primary care may be worth it to you. Likewise, if you appreciate Western and Eastern medicine and naturopathic or holistic forms of seeking/maintaining wellness, be sure your primary care physician does too.
Tip #3: Go for the hands-on physician.
Like all physician specialists, your primary care physician went to medical school and residency, so be sure your doctor exercises their knowledge and experience to serve you best. Remember, your primary care should be able to address 90% of patient needs. Over-referring costs you time and money, not to mention the potential of a significant delay in treatment. If your primary doctor refers more than they treat, it’s time to get a new one.
Tip #4: Go for the compassionate physician.
Physician burnout is real. A physician at risk of burnout may be impatient, irritable, tired, inattentive, or disinterested in discussing treatment options. Although physicians are human like everyone else, with good and bad days, they are held to an appropriately high standard as they deal with delicate and sensitive issues- and your life!
Tip #5: Go on more than someone else’s gut.
Word of mouth, family and friend experiences, and online reviews matter. However, try to keep each opinion in context. If a theme carries across more than one avenue of opinion(s), it will more likely reflect your experience as well. Sometimes when an individual’s expectations do not match a harm-to-help ratio, that person can create quite a biased stir. Physicians have a considerable responsibility to humanity, summed up in the Hippocratic oath: Do no harm. For safety reasons, a physician’s Hippocratic oath trumps the need to please.
Tip #6: Go for what’s best for you, not what your insurance dictates.
Doctors in-network are contracted to earn their living based on volume, billing/coding standards, and complex incentives, all pre-determined by the insurance carrier and health system managing these physicians. These physicians are told how to practice medicine and how fast they need to practice it. If you like paying for your health insurance to cover primary care and it works well for you, that is great; primary care is available within this model. However, please avoid being blindsided by hidden costs and copays. Direct primary care has no hidden fees. You really do get what you pay for.

Six Questions to Ask When Meeting a New Primary Care Provider:

  1. Are you board certified in Family Medicine? How long have you been in practice?
  2. What is the time delay between scheduling and the actual appointment? How long will I have with you on each visit?
  3. How do I contact you when I have a question during business hours? After hours? Will you or someone else be answering my questions/calls?
  4. What is your care philosophy? Can it be personalized for each patient? Do you practice any lifestyle medicine?
  5. How can you be my advocate in illness/injury, such as providing remote care? Work excuse? Work return? FLMA paperwork? Prior Auth for meds/tests?
  6. How do you protect my personal information?
Top Six Mistakes after you choose your Primary Care Provider:
Mistake #1: Not seeing your physician on a regular basis.
Primary care is the heart and soul of good medicine. Like any worthwhile relationship, it takes time to build knowledge and understanding within the patient-physician exchange. So much of primary care is dialogue, back and forth, creating and maintaining a foundation to assure that when something is not right, the pre-problem state is already known. Physicians can then activate a team approach to regain and rebuild.
Mistake #2: Believing your physician can’t make time for you.
In direct primary care, your physician’s sole purpose is to make time for you to meet your healthcare needs. If you require ongoing daily or weekly visits, months upon months, this is likely unreasonable. Direct primary care requires mutual and bidirectional patient-physician trust and respect to succeed.
Mistake #3: Assume no news is good news.
If you have yet to gain access to test results in the expected time frame, call your primary care office and check on the test status. High-volume clinics (2000-3000 patients) have difficulty staying abreast of their patients’ potential needs. Untreated abnormal findings are one of the leading triggers of lawsuits in healthcare. Direct primary care panels cap at 400-600 patients, which reduces the risk of unaddressed abnormalities.
Mistake #4: Being sick and not seeking help due to cost.
This occurs too frequently and speaks of a system failure, proving that health insurance is not healthcare. The solution lies within direct primary care; when you pay for direct access, you get direct access when you need it.
Mistake #5: Agreeing to see another clinician.
Your physician is yours for a reason. You have invested in them, and they in you. Whenever possible, do not jeopardize your health in the hands of someone who does not know you. Continuity is rewarded with conscientiousness, care, and compassion and can help reduce costs based on knowledge and history.
Mistake #6: Tolerating a lackadaisical patient-physician relationship.
Physicians can get overwhelmed and may have too many patients to manage and too many non-patient-centered tasks. However, this is not an acceptable excuse for your physician not to take the time to give you their best response to each of your questions. Time is money. If they don’t have time for you, take your money elsewhere.
Original document content by Douglas Farrago MD of Forest Direct Primary Care, www.forestdpc.com, compiled by Embrace with permission from Dr. Farrago.

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